Imagine the emotional rollercoaster of dealing with hair issues caused by cancer treatment, only to have your hair thin, change, or shed again because of the onset of chemical or surgical menopause. This double blow is a common occurrence, even for young women who have undergone cancer treatment and it can often feel like adding insult to injury. Despite its prevalence, the topic is seldom addressed, leaving women with insufficient knowledge and guidance on managing hair and scalp problems that persist well after the initial cancer diagnosis.
We understand the profound impact this can have on your daily life and are thrilled to have spoken with Eva Proudman, one of industry’s leading trichologists in the UK, with over twenty years of experience, to address all of your questions. Discover everything you need to know about hair thinning, changes, and scalp issues following your active cancer treatment in this article.
The Emotional Impact
Hair issues can have a significant impact on your identity and self-esteem, affecting your body image, quality of life, relationships, and well-being. Research has found that people who suffer from significant hair loss are more prone to psychological distress (1). Furthermore, depression, anxiety, and social phobia are also more prevalent in those experiencing hair issues (2).
Eva explains “It’s really emotional. That’s what people forget. Your hair isn’t really about how it looks, it’s about how it feels. And it can make you very anxious, it can make you depressed, it can stop you going to social situations and you become really hair aware. You notice every little thing about your own hair, you notice everybody else’s.”
Why Do Hair Issues Happen After Cancer Treatment?
Chemotherapy Hair Issues
The goal of chemotherapy is to eliminate the rapidly dividing cells within tumours. However, it is unable to differentiate between a cancer cell and a hair cell, resulting in hair loss. This shedding is merely superficial, as it remains intact beneath the surface. Therefore, after chemotherapy treatment has been completed and eliminated from the body, the hair will begin to grow back. However, there might be some changes in the hair’s appearance once it starts to regrow.
Post-Chemotherapy Hair Changes
Hair Colour Change
Chemotherapy can interfere with the body’s process of creating melanin that gives hair its colour, causing the hair to grow back with less pigment, appearing grey or slightly lighter or darker in shade.
Hair Shape Change
During chemotherapy, a cold cap can be used to help minimise blood flow to the hair follicles and reduce its impact on them, thereby preserving the hair. For cold caps to work effectively they must be tightly fitted to cover the scalp. On certain occasions, when pressure is applied to the scalp, the follicle may deviate from its usual circular form and adopt more of an elliptical shape. Consequently, this alteration can result in the hair acquiring a wave or a bend.
Chemical reactions can also cause changes in the shape of hair. Instead of growing linear out of the follicle like straight hair, it may curl before emerging. This can make the hair more difficult to manage, which may take adjustment.
6 Key Reasons for Hair Issues in Menopause after Cancer
1. Nutrition is Key
To keep hair healthy, it’s important to have a good balance of essential vitamins and minerals. These include all the B vitamins, Vitamin C, Vitamin D, Copper, Iron, Zinc and Magnesium. In particular, Zinc is important as it plays a key role in many chemical processes in the body that directly affect hair health. Additionally, whilst Vitamin A is great for the skin, too much of it can cause hair loss and other issues.
It is vital to remember that optimal nutrition is essential for women going through menopause. Eva frequently encounters a common scenario in clinic, where numerous women inexplicitly gain weight in menopause, leading to them reducing their calorie consumption or eliminating essential food groups. Consequently, this can lead to vitamin deficiencies and hair issues.
2. Depletion of Iron
During perimenopause, many women experience changes in their monthly cycles; sometimes becoming longer and heavier. Often, this can result in a depletion of stored iron, known as Serum Ferritin. Furthermore, a decrease in this level can lead to increased hair loss, which is often noticed whilst showering or brushing hair. Overall, the range can vary from as low as 10 to approximately 300 ng/mL. Importantly, Serum Ferritin levels can be within the ‘normal’ range but the level may still not be adequate for ideal hair growth. For optimal hair health, it needs to be between 70 and 80 ng/mL.
Eva frequently sees many perimenopausal and menopausal women in clinic whose Serum Ferritin has been significantly depleted. She adds that there is often a tendency to panic and many women stop washing and colouring their hair. Consequently, this has a negative effect and increases levels of anxiety and stress; elevating cortisol levels and putting the body into survival mode. As a result, since the hair follicle is non-essential, there will be an increase in hair shedding.
Vitamin Levels and Deficiencies
It is useful to have a blood test to identify any potential deficiencies in vitamin levels. Specifically, it is recommended that the blood test includes Serum Ferritin, Vitamin B12, Vitamin D, and one of the following: C-reactive protein (CRP) or Erythrocyte Sedimentation Rate (ESR), as they serve as markers for inflammation.
Following the test, your GP or registered trichologist can analyse the results to determine if your levels are optimal for maintaining healthy hair. If any deficiencies are detected, adjustments can be made to your diet or supplements can be prescribed to address them. Furthermore, any potential interactions with medications can be identified and managed. Additionally, you should be monitored over the course of several months, with supplements being adjusted as necessary.
3. Female Patterned Hair Loss
If you have the genetic predisposition for female pattern hair loss, you will likely notice that your hair’s central parting widens, more scalp becomes visible, the crown area may not sit well and the front may appear “see-through”. The cause of this is the gradual miniaturisation of the hair, resulting in its continuous thinning until it reaches a point where it can no longer grow. Moreover, if you’ve inherited the genetics, this needs to be treated separately; HRT alone is not enough.
4. Oxidative Stress
The skin on the scalp is constantly exposed to a significant amount of oxidative stress. When hormonal transactions change in the body, it affects the follicle, causing oxidative stress and free radicals, which impact the hair and scalp.
New Frontier in Hair Care
Supported by clinical research, Tricotain Hair Retaining Shampoo and Conditioner neutralise the detrimental impact of oxidative stress and harmful free radicals that lead to hair loss and damage to the hair. The shampoo is enriched with antioxidants that successfully reach the hair roots. Additionally, it enhances the penetration, absorption, and effectiveness of other treatments like topical Minoxidil. Furthermore, the conditioner specifically targets external oxidative stress, which can harm the hair fibres.
5. The Impact of Medications
Tamoxifen and Aromatase Inhibitors
Eva has observed that women who are prescribed Tamoxifen or Aromatase Inhibitors to block oestrogen production or to stop oestrogen from going to certain body parts experience various outcomes. For those women who don’t have the genetics for female pattern hair loss, there is generally little impact. Conversely, women who do have the genetic inheritance may develop female pattern hair loss a little greater and slightly quicker. However, she is keen to point out that this can be balanced and managed with the treatments for female pattern hair loss, which are not contraindicated to Aromatase Inhibitors; namely, topical Minoxidil, which sits within the hair follicle.
Laser Helmet Therapy: Shining a Light on Hair Growth
The presence of miniaturised hair can be stabilised and enhanced in terms of size and length through the use of low-level light therapy. As a result, this will help achieve maintenance and retention of the hair. Importantly, you need to consider when researching laser helmets, the inclusion of laser diodes, as it’s the depth of the light that permeates the follicle. Furthermore, whilst LED, infrared lights are suitable for skin, they will not work on hair.
Contraindications of Medicines
It is crucial to check with a GP or trichologist if there are any contraindications of the medicine you are taking. So for example, if you are taking an immunosuppressant that causes photosensitivity, using a laser helmet would be contraindicated. In such cases, a doctor or trichologist will be able to explain to you what your medications do and maybe offer alternatives.
Eva advises “If you’re taking something that is about keeping you alive, that is more important than the hair. And there are cosmetic things we can do for the hair if the treatment is limited. So there’s always a balance of what we can do, what we can treat, and what we can help with cosmetically”.
Cosmetic Boost: Hair-Building Fibre
Dani Binnington, Founder of Menopause and Cancer, top tip for a cosmetic boost to the hair is to use hair fibres, which mimic the look of fuller, thicker hair. These fibres are composed of Keratin, an amino acid protein; they have a positive charge that allows them to stick to the negatively charged surface of natural hair.
Antidepressants: Are They Hair-Friendly?
Medications play a part in overall hair health and there are certain antidepressants that are more “hair-friendly” than others. To clarify, some antidepressants can disrupt the growing and shedding cycle which makes it feel like loss. In clinic, Eva has generally found that Citalopram rarely causes hair shedding. Sertraline, however, may affect hair issues in some people; it depends on a person’s sensitivity to the medication.
Consequently, this can sometimes be counterintuitive to the use of the antidepressant to improve mood and reduce anxiety. Therefore it is important to find the one that works for you. In most cases, it’s about clear communication with your doctor and looking at all the options to have a little bit of balance and control. Furthermore, it should be noted that it’s imperative to consult with your doctor before changing or reducing antidepressants, to avoid unpleasant withdrawal effects.
6. Stress of a Cancer Diagnosis, Treatment, and Menopause
Receiving a cancer diagnosis, undergoing treatment, and subsequently experiencing often early onset of menopause with heightened symptoms can cause significant stress. Hence, it’s important to recognise the huge emotional impact this can have on your mind and body. In fact, studies have shown that women who experience high levels of stress are over ten times more likely to experience hair shedding (3). Therefore, arming yourself with a personal toolbox of lifestyle practices such as yoga, meditation, journaling, exercise, or walking in nature can help. Discovering what is right for you and integrating this into your life through small, achievable ways, can be beneficial.
Making Sense of Hair Issue Options
For some people, seeking the help of a trichologist may feel too much, too soon. For those not quite ready to see a trichologist or perhaps feel it’s not bad enough, making sense of the things that can really help can be a minefield.
Busting Hair Cure Myths
Can Rosemary Oil make hair grow?
Despite it being hailed as a magic ingredient that will make your hair grow faster, thicker, and longer as well as treat hair loss; it’s a myth. Specifically, Rosemary Oil is unique because it has two properties: soothing and energising. Therefore, Rosemary Oil is often used in treatment shampoos for itchy, flaky scalps. It can also be used for massaging the hair in a carrier oil.
Can Pitta Oil stop hair loss?
There are some hair products on the market that have Pitta Oil as an ingredient, which claims to promote faster and thicker hair growth while preventing hair loss. However, it’s important to note that this is only a cosmetic product and not a hair loss treatment.
Is Biotin hair’s best friend?
Research has shown that people who lack biotin (Vitamin B7) could enhance the condition of their hair, skin, and nails by taking supplements (4). Nevertheless, since biotin is present in almost every food group we consume, whether you follow a plant-based, pescatarian, or complete diet, chances are you are already getting enough. Therefore, the need for supplementation only arises if you have low levels or a deficiency.
Can B Vitamins help?
Vitamin B12 is exclusively found in animal proteins, meaning that people following a plant-based diet will not obtain this vitamin. For hair health and maintenance this needs to be in the 400-500 pg/mL range. Additionally, Vitamin B3 and B6 play crucial roles in hair vitality. Therefore, if considering supplementation, Eva recommends opting for a Vitamin B complex, which combines all the B vitamins and offers greater benefits.
What about Vitamin D?
Vitamin D is important for maintaining hair growth and the functioning of the immune system. It primarily originates from exposure to sunlight. Therefore, in winter, our intake of this vitamin often decreases which can lead to deficiencies.
What does Collagen do in a shampoo and conditioner?
Collagen within shampoos and conditioners can be beneficial for fine hair as they provide a volumising effect by adding a protein molecule to the hair which makes it look thicker.
Collagen supplements: are they necessary?
Collagen consists of amino acids that form proteins. To clarify, proteins are the building blocks of our human body, and there are 23 amino acids that our body requires daily. The body can produce all of these amino acids on its own, except eight essential ones, which are crucial for maintaining healthy hair. Therefore, if your diet lacks balance or if you are not consuming specific food groups, such as meat, eggs, chicken, beans, and fish, then incorporating a collagen supplement into your routine might be beneficial.
Collagen Quality and Effectiveness
Eva recommends opting for a marine collagen supplement, if suitable, as it is more easily absorbed by the body. In addition, liquid forms are preferable to capsules as they often contain unnecessary fillers and coatings. Importantly, you should also check the protein content, with 8-10g being the optimal range. Lastly, it is worth considering whether the brand invests in research and clinical trials to ensure its quality and effectiveness.
Collagen and Cancer Treatment
Before incorporating any dietary supplements, including collagen, into your routine, it is crucial to consult with your doctor or healthcare team. It is worth noting that supplements can potentially have side effects and may even interfere with your ongoing cancer treatment. If a collagen supplement is not suitable for you, there are alternative methods to enhance collagen production, such as maintaining a well-balanced diet that includes foods known to contain or promote collagen.
Dr. Nina Fuller-Shavell has written an extensive summary of the evidence around safety of collagen in this article here.
What can help scalp issues?
An imbalanced scalp is usually caused by the presence of yeast, which is particularly common in menopause or post-chemotherapy, as the oil glands on the scalp tend to produce excess sebum. As a result, the natural yeast on the scalp becomes overactive and causes inflammation. Juniper Therapy Scalp Treatment Shampoo addresses this issue by balancing the scalp; it has anti-inflammatory and anti-itch properties.
Support for Your Hair Issues in Menopause after Cancer
The double whammy of hair loss in menopause after cancer can feel like the final straw. But, there is hope and help available. It is important to take a personalised approach to find the best solution for your unique needs and be wary of any products that promise miraculous results without scientific backing.
When seeking support for your hair concerns, Eva encourages you “Not to feel like it’s vanity, don’t be embarrassed, don’t think anybody’s going to judge you. Quite the opposite. And if you can control your hair like you are, you’ve made that decision.” Understanding and clarifying the available options empowers you to take control over your decisions and make informed choices that are aligned with you.
Eva Proudman, is one of the industry’s leading trichologists in the UK, with over twenty years of experience. She is a Fellow of the Institute of Trichologists, a member of the International Association of Trichologists, and a member of the World Trichology Society.
(1) Hunt N, McHale S. Reported experiences of persons with alopecia Areata. J Loss Trauma 2005:10:33-50.
(2) Garcia-Hernandez MJ, Ruiz-Doblado S, Rodriguez-Pichardo A, Camacho F. Alopecia areata, stress, and psychiatric disorders: a review. J Dermatol 1999:26:625-32.
(3) York J, Nicholson T, Minors P, Duncan DF. Stressful life events and loss of hair among adult women, a case-control study. Psychol Rep 1998:82:1044-6.
(4) Patel D, Swink S, Castelo-Soccio, L. A Review of the Use of Biotin for Hair Loss. PMC 2017:3:166-169.
Hussain et al (2019) Psychological Effects of Hair Loss. DermNet: All about the Skin.
Disclaimer: The information provided in this article is for informational purposes only and should not be considered as a substitute for medical advice. Always consult your doctor, oncologist, or medical team.
Menopause and Cancer are not affiliated with any product or service mentioned or linked.
Written by Bettina Alderton, MSc Psych., BSc (Hons).
Registered Community Interest Company No: 14546307
Copyright © 2023 Menopause and Cancer | All Rights Reserved.
Keep up to date
Sign up to receive emails and keep up to date with events, workshops and our courses.
Improve your mental and physical wellbeing. You can join our services, workshops, programs and events at any time during and after your active cancer treatment. We welcome people affected by all types of cancers. Join us if you would like to be better informed about your choices of how to navigate the menopause and if you are seeking the support of a community who ‘gets you’.
To contact us email: firstname.lastname@example.org